The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline


For high-risk groups of hypertensive patients and those with hypokalemia, we recommend case detection of primary aldosteronism by determining the aldosterone-renin ratio under standard conditions and recommend that a commonly used confirmatory test should confirm/exclude the condition. We recommend that all patients with primary aldosteronism undergo adrenal computed tomography as the initial study in subtype testing and to exclude adrenocortical carcinoma. We recommend that an experienced radiologist should establish/exclude unilateral primary aldosteronism using bilateral adrenal venous sampling, and if confirmed, this should optimally be treated by laparoscopic adrenalectomy. We recommend that patients with bilateral adrenal hyperplasia or those unsuitable for surgery should be treated primarily with a mineralocorticoid receptor antagonist.

Authors: John W. Funder, Robert M. Carey, Franco Mantero, M. Hassan Murad, Martin Reincke, Hirotaka Shibata, Michael Stowasser, William F. Young, Jr
Keywords: endocrine society, practice guidelines, APA, aldosterone-producing adenoma, ARR, aldosterone-to-renin ratio, AVS, adrenal venous sampling, BAH, bilateral adrenal hyperplasia, CCT, captopril challenge test, CT scan, DRC, direct renin concentration, FH-I, FH-II, FH-III, familial hyperaldosteronism, FST, fludrocortisone suppression test, FUT, furosemide upright test, GRA, glucocorticoid remediable aldosteronism, IAH, idiopathic adrenal hyperplasia, IHA, idiopathic hyperaldosteronism, MR, mineralocorticoid receptor, MRA, PAC, plasma aldosterone concentration, PRA, plasma renin activity, SIT, saline infusion test, UAH, unilateral adrenal hyperplasia
DOI Number: 10.1210/jc.2015-4061      Publication Year: 2016

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